This past December, whistleblowers came to me, and they started warning about what they believed to be massive Medicaid home health care fraud here in the state of Ohio. They weren’t just talking about a few bad claims. They were actually describing what they believed to be a systemic fraud pipeline right here in Columbus.
These whistleblowers told me providers were being pressured to rubber-stamp home health care paperwork, and for people who actually didn’t medically need it. They said individuals would come into their office and ask for home health care services. Some appeared to be actually coached on what to say to get those services, with somebody, many times, who didn’t even speak English, so you had a translator in the office, and they were pushing aggressively for paperwork to be approved.
But these providers did the right thing. They conducted physical exams, they evaluated the person who was pushing for home health care services, and when the person didn’t qualify, they flat-out denied them. They refused to rubber-stamp Medicaid paperwork, which was the right thing to do.
The whistleblowers told me much of the pressure that they were seeing was actually coming through individuals and businesses operating within the Somali, Bhutanese, and Nepalese communities here in Ohio.
And they said that some of the health care agencies were even going so far as to suggest, and I quote, “I will make this worth your while if you approve the paperwork.”
Again, these providers...
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